【摘要】 目的 探讨CT三期增强扫描对孤立性肺结节(SPN)的定性诊断价值。方法 回顾性分析2018年1月至2021年12月南阳中心医院收治的82例SPN患者临床资料，所有患者均接受CT平扫和三期增强扫描，获取CT值、CT净增值(?CT值)和CT强化率。以病理结果为金标准，比较良、恶性SPN患者CT平扫、三期增强扫描的CT值；比较良、恶性SPN患者?CT值、CT强化率；计算CT三期增强扫描对SPN恶性诊断的准确性、敏感度、特异度、阳性预测值、阴性预测值和Kappa值；受试者操作特征(ROC)曲线分析CT三期增强扫描结果对SPN定性诊断的价值。结果 纳入患者82例，其中33例为良性SPN(40.24%),49例为恶性SPN(59.76%)；良性SPN和恶性SPN平扫CT值比较，差异无统计学意义(P> 0.05)；良性SPN的主动脉期、延迟期增强CT扫描CT值均显著低于恶性SPN，差异有统计学意义(P <0.05)；良性SPN以肺动脉期强化为主，三期?CT值及强化率比较，差异有统计学意义(P <0.05)；恶性SPN以主动脉期强化为主，三期?CT值及强化率比较，差异有统计学意义(P <0.05)；良性SPN肺动脉期、主动脉期的?CT值、强化率均显著高于恶性SPN，差异有统计学意义(P <0.05);CT三期增强扫描诊断SPN良恶性的敏感度、特异度为79.59%、81.82%(Kappa=0.602);ROC结果显示，CT三期增强扫描结果诊断恶性SPN的曲线下面积(AUC)为0.802，差异有统计学意义(P <0.05)。结论 CT三期增强扫描是SPN定性诊断的可靠方法，可作为SPN良恶性诊断的可靠影像学方法。更多还原

【Abstract】 Objective To explore the qualitatively diagnostic value of CT three-phase enhanced scan for solitary pulmonary nodules(SPN). Methods A retrospective analysis was performed on the 82 patients with SPN admitted to the hospital between January 2018 and December 2021. All patients underwent CT plain scan and three-phase enhanced scan to obtain CT value,net added value of CT(ΔCT value) and CT enhancement rate. Taking pathological results as the golden standard, CT values of CT plain scan and three-phase enhanced scan, ΔCT value and CT enhancement rate in patients with benign and malignant SPN were compared. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of CT three-phase enhanced scan in the diagnosis of malignant SPN were calculated. The qualitative diagnosis value of CT three-phase enhanced scan for SPN was analyzed by receiver operating characteristic(ROC) curves. Results A total of 82 patients were included, of which 33 cases(40.24%) with benign SPN and 49 cases(59.76%) with malignant SPN. There was no significant difference in CT value of plain scan between benign SPN and malignant SPN(P > 0.05). CT values of enhanced CT scan during aortic phase and delayed phase in benign SPN were significantly lower than those in malignant SPN, and the difference was statistically significant(P < 0.05). Benign SPN is mainly enhanced in the pulmonary artery phase and there were significant differences in three-phase ΔCT value and enhancement rate(P < 0.05). Malignant SPN is mainly enhanced in the aortic phase, and there were significant differences in three-phase ΔCT value and enhancement rate(P < 0.05). The ΔCT value and enhancement rate during pulmonary artery phase and aortic phase in benign SPN were significantly higher than those in malignant SPN, and the difference was statistically significant(P < 0.05). The sensitivity and specificity of CT three-phase enhanced scan in the diagnosis of benign and malignant SPN were 79.59% and 81.82%(Kappa=0.602). ROC results showed that the area under the curve(AUC) of CT three-phase enhanced scan in the diagnosis of malignant SPN was 0.802, and the difference was statistically significant(P < 0.05). Conclusion CT three-phase enhanced scan is a reliable method for the qualitative diagnosis of SPN, which can be applied as a reliable imaging method for the diagnosis of benign and malignant SPN.更多还原